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Artificial disc replacement / insurance denial as "experimental"

AnonymousUserAAnonymousUser Posts: 49,731
edited 06/11/2012 - 8:25 AM in Health Insurance Issues
Does anyone have resources for finding out what insurance companies' medical policies are on whether artificial disk replacement is "new and unproven"?

I have read that Aetna allows 1 cervical disk replacement (and seen the policy). United Healthcare has denied my request for 2 cervical disk replacements. I have heard they have negotiated to pay for the surgery (but not this disks) for other patients. I have heard BlueCross does not pay for any disk replacements.

I may have the opportunity to get on a Guardian Health plan, and I have read their descriptions of the reasons they may deny experimental surgery.

There are 2 hurdles to cross:
1) Whether ADR is experimental or unproven
2) Whether 2-level ADR is approved by the FDA (the devices are approved for only 1 level to my knowledge)

Any thoughts? Any relevant experiences would be much appreciated!

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Comments

  • Please check the archived threads under this topic. There have been many discussions on the old board of getting approval from insurance company for this surgery. There were folks that were successful and they explained how. Good luck to you.
  • I wish you the best of luck. I fought BCBS Excellus from Feb 08 and end of Aug 08 for ADR and they refused due to investigational/experimental. I went all the way up to the NYS insurance dept and ended up having a fusion because the insurance company would not approve the surgery no matter how much proof the doctor's and I gave them. I was so mad and lost my job in the meantime because it took so long fighting the insurance company and then recovery time from surgery.

    Best of luck to you.
  • I was wondering how far you have gotten along with your research so far. You look so young for this pain etc. The last surgeon I saw for a 2nd opinion said I was too young (44) for 4 surgeries on my back so far!

    I am scheduled for an ALIF on Monday with a Fusion L3-S1 on Tuesday and am very scared. I have been doing some research on artificial discs and the success they have been having. In Germany over 20 years they have been doing them. I am living off of my savings and if I did this surgery that would be all my money. I would be homeless --that is how strongly I feel about this potential and I am an R.N.

    Let me know how you are doing with your therapy and your fusion. It sucks that you worked so hard to get insurance to pay for it and had to get the metal put in. It seems like you are still in a lot of pain. Have you been able to cut back on your pain meds at all?

    I hope my stuff shows up beneath my message so you could see where I am at.

    Bless you for trying and don't quote me on this but so far with my research I think that regardless of your fusion - I think you may still have the option of artificial discs later. That's what I am holding onto.
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